Ministry
of Health Uganda
Objective
To improve women's access to
prompt and effective treatment of obstetric complication by working with
the community to recognise complications and convincing them that medical
care is needed; and to facilitate access to quality care by improving
communication and transport.
Background
The initiative referral system
called the Rural Extended Services and Care for Ultimate Emergency Relief
(RESCUER) was set up in the district of Iganga as a pilot project to
reduce maternal mortality. RESCUER'S success was based on innovative
communication, transportation and health referral system, the project
provided emergency obstetric care which saved lives of many women.
Scope
Started in 1995 and a pilot
basis for one and a half year in a chosen district, the experience has
proven that when an effective referral system is in place, maternal
mortality can be reduced based on this successful effort. It is currently
being expanded by the Ministry of Health.
Main Activities
In the case of obstetrics
emergency, the TBAs or SMA instantly make contact with the health referral
points using a two-way radio system. She received instructions on how
to manage the case while waiting for the first level referral health
units to send the motorised tricycle to transport the patient to the
identified health unit where facilities are available to provide the
obstetric care.
Evaluation Findings
The hospital figures in the
RESCUER pilot project areas showed a considerable increase in referrals
related complications and a decline by about 80 percent in maternal
deaths in the six month period after expansion has taken place. A significant
increase in cesarean sections has also been noticed and which would
otherwise ended in maternal deaths.
|
Management Features
Strategy
Prompt actions in getting proper
attention in the management of obstetrics is through improving communication
between health providers and users, improving transport between villages
and referral health units and access to high quality services.
Capacity building
The project focussed on referral
system and to ensure that the system function effectively, staff of
each level were trained / retrained. Training of TBAs in the basics
of reproductive healthcare was ongoing in the district and selected
TBAs were given training on usage of the radio equipment.
Managing resources
The pilot project was funded
by UNFPA and further expansion was taken by the Ministry of Health projects.
The districts were given the responsibility to setup and implement their
own referral system.
Managerial leadership
The Ministry of Health has
established a safe motherhood programme to address specifically the
problems that contribute to high maternal deaths. Quality awareness
workshops introduced quality management methods to district health teams
and as a result the success of the RESCUER project.
Concessions were obtained
to enable the staff of the health referral unit to perform some of the
procedures that had hitherto not allowed at the health centers has contributed
to the reduction of maternal health.
|
